Healthcare Consulting

Our consulting services are in demand by healthcare systems, hospitals, and medical practices.  A list of our consulting services is provided below to acquaint you with our customized approach to clients and their needs.

Physician-Hospital Integration

We work with physicians, hospitals and integrated systems to create collaborative care models aligned with today’s value-based reimbursement. Whether your organization is already part of an accountable care network and seeks to improve its integration and alignment for shared savings models or value-based reimbursement or whether it is just now forming an integrated system, we align the governance structure and clinical and business operations for successful, sustainable performance to permit a ‘system of care’ to be delivered to patients. 

We work with clients to create the business infrastructure to permit optimal value-based care, including:

  • Governance and decision-making
  • Ambulatory care redesign
  • Financial and payer contracting
  • Business intelligence and business value
  • Innovative delivery systems
  • Quality and cost management

We address the following specifics in the design of integrated care models.

Feasibility Assessment                                                                                                          

  • On-site meetings with hospital leaders and physicians to discuss integration goals, issues, and concerns related to physician-integration
  • Education and perspective regarding key integration issues including those relating to autonomy, financials, and delivery system change
  • Current financials and create financial model involving revenue diversification, compensation planning and income distribution
  • Practice collaborative opportunity involving analysis of current delivery system infrastructure and practice operations with recommendations for innovative, value-based care

Facilitated Planning and Decision-making

  • Business and clinical operations modeling of near-term and long-term goals and strategies
  • Implementation “strategies and tasks” plan to guide the implementation process

Implementation Support

  • Implementation support based on the findings, feasibility assessment and planning process
  • Coordination with legal counsel as needed in connection with transition closing

Strategic Planning and Alignment

Health systems and medical practices operate in an intense, dynamic environment that demands that organizations adapt, be responsive, and achieve rapid change.  We work with clients to determine strategic alignment opportunities to build competitive advantage. We conduct a systems evaluation of the organization and its microsystems, to include analysis of its alignment with:

1)    The external healthcare environment, and

2)    The organization’s internal management coordination systems – to include governance, leadership, financial and practice operations. 

We work with organizations to create a new management coordination systems framework, one that strengthens competitive advantage and effectively positions the organization within its market.  This includes strategic planning, ambulatory care optimization and business intelligence to align the organization for the future.

Physician Compensation Plan Redesign

Productivity-based compensation plans that reward physicians for work volume are being supplanted with plans that reward physicians for value, defined as high quality, low cost and appropriate care. We work with leaders to identify specific plan goals, design principles, funds flow model, plan architecture, and plan methodology for physician compensation plan re-alignment.

We address each of the key components of physician compensation plan design, including:

1) Funds flow model - the revenue sources available for compensation and the expense treatment,

2) Compensation plan architecture - the framework for the plan, e.g., individualistic versus team, productivity versus base-plus-incentive, and

3) Plan technical dimensions – the specific revenue and expense treatment and the specific measures of productivity, cost, quality and service measures for the plan.

We facilitate the dialogue and communication between leaders and physicians to ensure active engagement of physicians in the compensation plan redesign process.  A detailed implementation plan moves the organization from its current state to the future state, minimizing the disruptive effects of physician compensation plan realignment.

Physician Transition Plan Development

More and more physicians are seeking to work part-time or via a schedule that differs from the group norm.  Each one of these requests should not be treated as if it is an idiosyncratic event, but rather follow a carefully defined pathway that permits both the requesting physician and the practice to plan and thrive.  We work with clients to develop transition plans to manage requests for physician slowdown, part-time, and retirement.

The following areas are impacted when a physician seeks a pattern of work that differs from the group.  Each of these areas is  addressed in a formal transition plan:

  • Governance
  • Voting rights
  • Partnership status
  • Financials
  • On-call schedules
  • Compensation plan
  • Ancillary revenue distribution
  • Practice buy-out

Each transition plan is unique.  While goals and principles, current state, and plan mechanics are all part of a transition plan, facilitated discussion with the group is used to create a plan that is specific to the group and aligned with its strategy and culture.

Revenue Cycle Optimization

Today’s revenue cycle is increasingly focused on the front-end, as we work with patients and payers to identify coverage, eligibility and out-of-pocket payments, to include deductibles, coinsurance, copayment and patient balances prior to the visit.  We identify industry “best practice” opportunities for professional fee billing improvement, as well as assess the structure, staffing, capacity and resource allocation of the revenue cycle. An implementation plan with cost/benefit analysis, projections for increased collections and prioritization helps clients enhance the financial health of their practices.  

Each of the following key areas are assessed for revenue cycle optimization:

Key Performance Indicators

  • Custom benchmarking analysis of key billing metrics with comparison to peer practices and best practice performance
  • Revenue cycle dashboard to include leading financial indicators, operational definitions and performance targets

Process Improvement Findings and Recommendations

  • Front-end billing – to include patient financial clearance, charge capture, coding, charge entry and time-of-service collections optimization
  • Data integrity – to include claims management, cash management payment posting, credits and refund processing, and collection agency coordination
  • Reimbursement management – to include insurance and patient account follow-up, customer service, and denial management
  • Business intelligence – to include technology support, management reporting and financial policies and procedures

Business Office Staffing Deployment Model

  • Detailed analysis of current staffing, with comparison to benchmarks and expected staff workload ranges for each key revenue cycle function
  • Staff recruitment and retention
  • Staff education, training, and performance audits

It is important to collect every dollar that is due the practice, while at the same time positioning the practice to succeed in a consumer-driven healthcare environment that combines fee-for-service with value-based reimbursement.  

Practice Operations Excellence

We conduct an onsite practice operations assessment to identify opportunities to improve practice operations consistent with ‘best practice’ performance in the areas of:

  • Patient access;
  • Patient flow;
  • Staffing deployment; and
  • Practice efficiency.

Each of the four patient flow processes needs to be aligned and functioning optimally for the medical practice to achieve high performance:

  1. Pre-visit patient financial clearance;
  2. Scheduling and telephone management;
  3. The face-to-face visit; and
  4. Virtual medicine, including secure email messaging, e-visits, and telehealth.

Innovative delivery models are recommended for clients based on their current readiness and capabilities, to include patient-centered medical home, 24/7 patient access, virtual medicine, real time consult capability, patient navigation, care outreach, transition management and shared decision-making with patients.

Staffing Deployment Models

We analyze the staffing deployment model for the medical practice to determine if the practice has the right staff doing the right things.  Each key patient flow process is analyzed with regard to current and future staffing deployment, to include telephones, front office, back office and billing staff support.  We employ benchmarking, workload analysis, and work process redesign to identify improvement opportunity to align staffing with the work of the practice’s clinicians.  We identify ways to expand patient access to care via the use of a care team model.

Changes to the patient flow process are recommended to improve practice alignment with ‘best practice’ performance and delivery system reform.  We provide staffing strategies for:

  • Virtual medicine
  • Patient-centered medical homes
  • Expanded patient access
  • Consumer-driven healthcare
  • Value-based reimbursement
  • Accountable care demonstration

Our goal is to help you “staff for the future now” and position your practice for future success.